Medical Power of Attorney Form - Texas
TEXAS MEDICAL POWER OF ATTORNEY
INFORMATION CONCERNING THE MEDICAL POWER OF ATTORNEY. THIS IS AN
IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD
KNOW THESE IMPORTANT FACTS:
Except to the extent you state otherwise, this document gives the person you name as your agent the
authority to make any and all healthcare decisions for you in accordance with your wishes, including
your religious and moral beliefs, when you are no longer capable of making them for yourself.
Because “healthcare” means any treatment, service or procedure to maintain, diagnose or treat your
physical or mental condition, your agent has the power to make a broad range of healthcare decisions
for you. Your agent may consent, refuse to consent, or withdraw consent to medical treatment and
may make decisions about withdrawing or withholding life-sustaining treatment. Your agent may not
consent to voluntary impatient health services, convulsive treatment, psychosurgery, or abortion. A
physician must comply with your agent’s instructions or allow you to be transferred to another
physician.
Your agent’s authority begins when your doctor certifies that you lack the competence to make
healthcare decisions.
Your agent is obligated to follow your instructions when making decisions on your behalf. Unless
you state otherwise, your agent has the same authority to make decisions about your healthcare as
you would have had.
It is important to discuss this document with your physician or other healthcare provider before you
sign it to make sure that you understand the nature and range of decisions that may be made on your
behalf. If you do not have a physician, you should take with someone else who is knowledgeable
about these issues and can answer your questions. You do not need a lawyer’s assistance to complete
this document, but if there is anything in this document that you do not understand, you should ask a
lawyer to explain it to you.
The person you appoint as agent should be someone you know and trust. The person must be 18
years of age or a person under 18 years of age who has had the disabilities of minor removed. If you
appoint your health or residential care provider (e.g. your physician or an employee of a home health
agency, hospital, nursing home or residential care home, other than a relative), that person has to
choose between acting as your agent or as your health or residential care provider; the law does not
permit a person to do both at the same time.
You should inform the person you appoint that you want the person to be your healthcare agent. You
should discuss this document with your agent and your physician and give each a signed copy. You
should indicate on the document itself the people and institutions who have signed copies. Your
agent is not liable for healthcare decisions make in good faith on your behalf.
Even after you have signed this document, you have the right to make healthcare decisions for
yourself as long as you are able to do so and treatment cannot be given to you or stopped over your
objection. You have the right to revoke the authority granted to your agent by informing your agent
or your health or residential care provider orally or in writing, or by your execution of a subsequent
medical power of attorney. Unless you state otherwise, your appointment of a spouse dissolves on
divorce.
This document may not be changed or modified. If you want to make changes in the document, you
must make an entirely new one.
You may wish to designate an alternate agent in the event that your agent is unwilling, unable, or
ineligible to act as your agent. Any alternate agent you designate has the same authority to make
healthcare decisions for you.
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